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Reform-Minded Care Coordination

For the Low-Income Uninsured

SCHA Reengineering Committee MeetingFebruary 11, 2011

An effective Delivery System

Primary Care

Medications

Specialist Care

Urgent/Emergent Care

Hospitalizations

Ancillary Services

Home Care

Dental Care

Mental Health Services

Health Education

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Access Gaps Identified

3 Safety Net providers – all at capacity

Limited Specialist availability for uninsured

No Adult Dental Care for uninsured

ERs: 48% visits, non-emergent

Frequent utilizers: 3 contacts/month/person

$116 million charity care 2009

Societal Factors

Education: < 20% Adults have College Degree

Poverty: > 14% Unemployment: > 10%

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AccessHealth South Carolina

The Duke Endowment

Helping Communities Build Networks of Care for the Uninsured

Timeline

March 2009 Application for year long planning grant

July 2009 Planning Grant awarded October 2009 Application for Implementation

grant December 2009 Implementation Grant

awarded July 2010 Doors open

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A Coordinated Community Approach

to

Caring for the Uninsured

An effective Delivery System

Primary Care

Medications

Specialist Care

Urgent/Emergent Care

Hospitalizations

Ancillary Services

Home Care

Dental Care

Mental Health Services

Health Education

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Mission

To improve access to healthcare for the uninsured of Spartanburg County through sustainable health system change that will result in better health outcomes and 100% access to effective, efficient, safe, timely, patient-centered, and equitable healthcare.

Access to Care = Improved Outcomes + Decreased Costs

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Clients: Uninsured Spartanburg County residents 150% Federal Poverty Level or below Ages 19 to 64

Program Overview

29,183 potential participants!

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Services: Eligibility for Fed/State/Local programs Initial Assessment Connection to medical homes and specialty services Care coordination Approach: Team-oriented, Holistic, Patient-centered

Focus: Measurement-based Outcomes Community provider IT connectivity

( a minimal risk testing ground for Healthcare Reform-Redesign)

Program Overview

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Engaged community partners Better Use of Local Resources Improved health status

Shift from “crisis care” to “ prevention, early intervention and disease management”

More efficient care and reduction in healthcare costs Reduction in inappropriate EC and IP use Reduction in hospital readmission rates Coordinated entry into program at time of discharge

Reduction in demand for taxpayer-funded services

Program Outcomes

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Structure

•Separate Non-profit

•10 Community Partners

•5 Member Board

Currently seeking 501 c 3 status

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Public Health Department Both Hospital Systems FQHC Free Medical Clinic Department of Mental Health Alcohol and Drug Abuse Commission Welvista (Statewide Medication Program) Spartanburg County Medical Society USC Upstate

Community Partners

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Director Eligibility Specialist

RN Care Navigator LBSW Care Navigator Americorps VISTA

Program Staff

Capacity with Internships

Multiple college partnerships Virginia College USC Upstate Mary Black School of Nursing Limestone College Converse College

Multiple roles to fulfill

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Falls under the Americorps VISTA Development of Volunteer Manual and Orientation Recruitment Strategy 3 volunteers currently; 4 additional needed Duties include reception/front office, answering phones, data entry, assisting with Gift in Kind, creating client cards

Capacity with Volunteers

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• Physician Recruitment

• Primary care and Specialists

What’s in it for me?

Volunteer Provider Network

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Provider Network

What Primary Care Providers want:

Case management support to assist patients with psychosocial needs and barriers to care

What Specialists want:

Buy in from Primary Care, medical homes for current patients

Provider Network

Current count of PCPs in network: 108 Current count of Specialists: 166 Efforts by Regional Physician Network and Mary

Black Hospital practices

Model: No reimbursement for services

All Aboard or derailment

DoctorsHospitalsSocial services

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Technology Component

Care Management software (Care Scope)

Coordinated Eligibility program (Benefit Bank) web-based platform Federal, State, and Local Services

Community Health Information Exchange Mechanism for providers to access health

information about shared patients

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285 client participants enrolled in pilot 385 eligibility screenings performed 193 medical home assignments 38 Specialist Referrals to date 1,855 appointments made 112 Rx program enrollment and/or assistance 104 applications for benefits through The Benefit Bank 37 clients in smoking cessation programs 7 GRADUATES!

Progress to Date

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Referrals 5 Rehabilitation (Regional Rehabilitation Services) 6 Alcohol and Drug (SADAC) 7 Housing (Mostly to Housing Authority) 28 Financial Assistance 37 Counseling (10 to PACE, 10 SADMH, 17 to Westgate)

Progress to Date

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Race

Client Demographics

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Age Median Age is 46 years, 308 days Oldest: Born 6/30/1929, 81 years 193 days old Youngest: Born 11/29/91, 19 years 72 days old

Client Demographics

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Location 160 live in the

City of Spartanburg (56.7%)

Client Demographics

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Poverty level

Client Demographics

AccessHealth Measurement System Case Management Software

Stores Client Case Files & Record of Encounters Potential to Connect with Other Systems… HIE

State Level Data Warehouse Connectivity among Hospitals Data Warehouse Assigns Unique Identifier to

Records, so Anonymity is maintained

In-House Tools Return on Investment Calculators with Excel & Access

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AccessHealth Measurement System Feeds Logic Model

Measuring Inputs Number and Types of Volunteer Physicians Number of Medical Homes Outlets for Obtaining Prescriptions Dollars Invested & In-Kind Contributions

Measuring Outputs Number of Appointments Made & Number Kept Types and Counts of Services Provided

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AccessHealth ROCI

Investments Grant dollars in In-Kind Support (e.g., rent for donated space) Calculated value of physician office visits, labs, radiology,

scheduled OP surgery

Outcomes/Returns ER & IP Cost Savings Economic Value of Health Behavior Changes Economic Value of Employable Clients

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AccessHealth ROCI Investments

Total Year 1 = $480,000

Outcomes/Returns Total Year 1 Hospital Est. Cost Savings = $574,096 Total Year 1 Client Est. Benefit = $120,967 Total Year 1 Employer Est. Benefit = $12,472 Total Year 1 Community Est. Benefit = $9,094

149% Return on Community Investment “For every $1 invested in the program, there is $1.49

returned in benefits.”

First Annual Report30-365 days pre-post Welvista enrollment

Decreases in Visits & Charges

9/1/2009 thru 7/1/2010(138 IP or ER patientsEnrolled in 12 months)

Emergency (-25% reduction in visits) Inpatient (-60% reduction in visits)

-$1,126/Patient

-$23,755/Patient

90 Pre 90 Pre90 Post

90 Post90 Post

90 Post

Comparative SampleSelf-pays (no Welvista) 30-365d pre-post

Increases in Visits & Charges

(501 IP or ER patients in 9 months)

Emergency (14% increase in visits) Inpatient (62% increase in visits)

$596/Patient

$8,579/Patient

90 Pre 90 Pre90 Post

90 Post90 Post

90 Post

all before-after 2 tests sig. at p<.001

Welvista Patients vs. Comparative Sample with no Welvista

Pre-Post Charge Comparison

ROI

Welvista Charge savings = $3,433,655

Welvista Cost Savings = $515,048

Hospital Investment in Welvista = $250,000

ROI = 206%

+

Charge Avoidance = $904,388

Cost Avoidance = $135,658

Net Cost Return = $650,706

NROI = 260%

Challenges

Continued partner engagement Uncovering system failures Fundraising

United Way’s Safety Net Council

Community agencies Case submissions each

month “Grand rounds” Case follow up

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“System Issues”Patient-centered Medical Homes

Chronic Disease Mgt StrategyMental Health resourcesDental Care

What’s missing?

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“Tonya” Female, age 33 Dropped from Medicaid while 5 months pregnant Type I Diabetic Need for medical home, support services for Tonya and her children Medical home established, readmission of Tonya with OB Healthy baby born on (date) Medicaid application completed, accepted…client graduated

Get to know a patient…

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“Frank” Male, age 55 Resident of homeless shelter Need for medical home, suspected he had high blood pressure Assigned to medical home Provider diagnosed high blood pressure and diabetes Medication and education provided; health disaster prevented

Get to know a patient…

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Questions?